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Book Forum: Psychotherapies   |    
Odysseys in Psychotherapy
JOHN C. MARKOWITZ, M.D.
Am J Psychiatry 2002;159:508-a-509. doi:10.1176/appi.ajp.159.3.508-a
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New York, N.Y.

Edited by Joseph J. Shay and Joan Wheelis. New York, Irvington/Ardent Media, 2000, 428 pp., $44.95.

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The editors begin inauspiciously by asking, "Is psychotherapy a science or is it poetry? Is this even a meaningful question to ask?" Such musing led them to ask "luminaries of psychotherapy" to recount their careers and what they "believe" about psychotherapy (p. ix). The authors then wonder, "If an asteroid were arriving…soon to shatter our planet…[with] loss of most human life and recorded thought" (p. 1), which psychotherapy books would we wish to survive? Such overheated, jejune writing risks having the reader stop before reaching the psychotherapists’ autobiographies that follow.

The editors’ premise is that the lives of "a wide range" (p. 8) of prominent psychotherapists should illuminate the field. Even conceding the value of the wisdom of exemplars, one questions the editors’ method. They claim to have recruited "stellar and internationally renowned therapists" of "the second half of the 20th century" (p. 7), but their selection is skewed. Most of the 16 alphabetically presented participants (nine men, six psychiatrists, six psychoanalysts, mainly Boston-connected, and one apparently the father of one of the editors) have decidedly psychodynamic backgrounds. Are they luminaries? I recognized about half the names. None is an empiricist, and most mention psychotherapy outcome research only naively and dismissively. Aaron Beck, presumably an important innovator, does not even make the index; nor do many others. Most cited, after authorial self-reference, is Freud. The reader never learns the rationale for selection, or how many therapists were approached but declined to participate.

Not all psychotherapists make superb memoirists. The writing is sometimes self-indulgent, self-important, and self-promoting. Some writers have led interesting lives, but most list events or define theory rather than describe their emotions in depth. Boston training programs evidently once taught elitist, paternalistic, misogynistic, rigidly intrapsychic psychodynamic theory, against which many of these writers rebelled. Their accounts reflect this with a vengeance: many have utterly abandoned an internal perspective, from which we might have learned the determinants of their decisions, to focus instead on externalities.

There are exceptions, such as the rousingly opinionated septuagenarian Sophie Freud’s ambivalently agnostic attitude toward her grandfather. Maltsberger, Pines, and A. Wheelis recount moving histories; Wachtel argues well. But the most surprising aspect of this book is the impersonality of most therapists’ self-disclosure. Their opacity obscures how their lives explain their therapeutic direction. We learn that they changed, but not why—a singularly unsatisfactory result. Perhaps focused interviews—a more psychotherapeutic format—would have yielded greater introspection and information.

Some therapists, rejecting the old faith, converted to new ideologies: ethnocultural psychology, lesbian feminist psychiatry, social constructionism, relational psychology, and even psychoanalytic parapsychology! As nonempiricist clinicians, they can offer only opinions and exhortations to support their approaches, resulting in what A. Wheelis calls a "chorus of contending voices" (p. 402) of seemingly equal valence. As a helpful guide to the future, this serves only as a cautionary example.

The volume’s late-20th-century time frame coincides with the collapse of long-term psychoanalytic hegemony. Most authors unsurprisingly seem to have moved from longer to briefer treatments and from an intrapsychic, theoretical focus to a more experiential, "responsive, connected relationship" (p. 77) with patients. They responded to the social unrest and liberation groups of the 1960s and 1970s. One acknowledges, "My coming of age…paralleled changes in the mental health field" (p. 84). Rather than highlighting individual differences, the book leaves an impression of secular change and reads best as an informal history of the already fading, pre-empirical, pre-managed-care era. Although the editors hope to provide "clues to the future" (p. 403), the psychotherapeutic prognostications are unhelpful, banal, or curious, auguring deterioration of therapeutic expertise under managed care or emergence of the "therapist-shaman-psychopharmacologist-psychotechnologist" (p. 62). The book is more oddity than odyssey.

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